Presentation of dizziness in individuals with chronic otitis media: data from the multinational collaborative COMQ-12 study

Comparison of Lateral Semicircular Canal Dysfunction in Chronic Otitis Media Patients using Air Caloric Test and Video Head Impulse Test

In developing nations like India, chronic otitis media (COM) is a common middle ear ailment that has serious ramifications for both hearing and quality of life. Long-term inflammation of middle ear cavity and tympanic membrane are the hallmarks of COM, which can result in consequences like facial paralysis, labyrinthitis, hearing loss, and potentially fatal cerebral abscesses. The effect of COM on vestibular function is still unknown. Studies reveal a positive correlation between the severity of COM and vestibular impairment, which may point to a cause-and-effect link. Using air caloric testing and video head impulse testing (VHIT), this study seeks to explore the link between vestibular symptoms, particularly lateral semicircular involvement with COM. To quantify the involvement of lateral semicircular canal using air caloric test and video head impulse test, compare the results of both tests in patients with chronic otitis media and to detect early labyrinthine dysfunction using air caloric test and Video head impulse test. A cross-sectional study was conducted over a period of 2 years to investigate the involvement of the lateral semicircular canal in patients aged 18 years and above with symptoms suggestive of chronic otitis media. All patients underwent air caloric and video head impulse tests, to evaluate canal paresis and horizontal vestibulo-ocular reflex (VOR). The outcomes of both tests were compared to investigate their correlation and diagnostic value. A total of 145 patients were enrolled in this study, with a median age range of 30-39 years and the gender distribution was nearly equal. The majority of patients (85.5%) presented with mucosal type chronic otitis media (COM), while 14.5% had squamosal type COM.Video head impulse test (VHIT) revealed abnormalities in 45.5% of patients, whereas the air caloric test (ACT) showed abnormalities in 21%. A positive head impulse test was observed in 11 patients (14.5%). Patients with medium and large-sized central perforations were more prone to giddiness. Labyrinthine fistula was detected in one patient with active squamosal disease. 56.1% of patients with abnormal VHIT had normal canal paresis and only 29 patients (43.9%) showed both abnormal VHIT and Air caloric test. VHIT is found to be more sensitive compared to air caloric test. The study highlights the significance of utilising both VHIT and ACT in the comprehensive evaluation of vestibular function in patients with COM. For individuals with vestibular deficits due to COM, a combined approach can improve diagnostic accuracy and guide targeted therapy and rehabilitation options.

Long-Term Impact of Recurrent Acute Otitis Media on Balance and Vestibular Function in Children

BACKGROUND/OBJECTIVES

Recurrent acute otitis media (rAOM) is a common disease in childhood, but its impact on the vestibular system remains poorly understood. The present study aimed to evaluate the long-term effects of rAOM on balance and vestibular function in pediatric patients.

METHODS

A total of 55 children, aged 8 years (25 males and 30 females), with a documented history of rAOM, no AOM episodes in the past year, and no previous ear surgery were assessed. Static posturography was used to assess postural instability, measuring sway area (SX, mm2) under four conditions: eyes open and eyes closed, with and without foam pads. Vestibular function was evaluated using the video head impulse test (v-HIT) to quantify vestibulo-ocular reflex (VOR) gain and corrective saccades across all six semicircular canals.

RESULTS

Children with a history of rAOM demonstrated significantly greater postural instability than healthy controls (p < 0.001 for all test conditions). The number of AOM episodes was the primary factor influencing balance dysfunction, with children who had more than eight episodes showing the most pronounced deficits in postural stability (p < 0.05). In some cases, the v-HIT revealed hypofunction in the right anterior (14.5%), left posterior (7.3%), left lateral (5.5%), left anterior (3.6%), and right posterior (3.6%) semicircular canals.

CONCLUSIONS

The results of this study suggest that rAOM can lead to lasting balance and vestibular dysfunction, highlighting the importance of early monitoring and potential rehabilitation.

Dizziness in adults with chronic otitis media at two otology referral centres in Colombia: a cross-sectional study in a middle-income country

OBJECTIVE

This study aimed to determine the prevalence of dizziness and its associated factors in patients with COM at two otologic referral centres in a middle-income country.

DESIGN

Cross-sectional study. Adults with and without COM diagnosis from two otology-referral centres in Bogotá (Colombia) were included. Dizziness and quality of life were assessed using the "Chronic Suppurative Otitis Media Questionnaire-12" (COMQ-12), and sociodemographic questionnaires were applied. Otoscopic evaluation and audiometric data were collected.

STUDY SAMPLE

A total of 231 adults.

RESULTS

Of the 231 participants, up to 64.5% (n = 149) reported at least mild inconvenience due to dizziness. Factors associated with dizziness included female sex (aPR: 1.23; 95% CI: 1.04-1.46), chronic suppurative otitis media (aPR: 3.02; 95% CI: 1.21-7.52), and severe tinnitus (aPR: 1.75; 95% CI: 1.24-2.48). An interaction was found between socioeconomic status and educational level, with more frequent reports of dizziness in the middle/high economic status and secondary education (aPR: 3.09; 95% CI: 0.52-18.55; p < 0.001). Differences of 14 points in symptom severity and 18.5 points in the total score of the COMQ-12 were found between the groups with dizziness and without dizziness.

CONCLUSIONS

Dizziness was frequent in patients with COM and was associated with severe tinnitus and quality of life deterioration.

Panel 1: Epidemiology and global health, including child development, sequelae and complications

OBJECTIVE

To summarise the published research evidence on the epidemiology of otitis media, including the risk factors and sequelae associated with this condition.

DATA SOURCES

Medline (PubMed), Embase, and the Cochrane Library covering the period from 2019 to June 1st, 2023.

REVIEW METHODS

We conducted a broad search strategy using otitis [Medical Subject Heading] combined with text words to identify relevant articles on the prevalence, incidence, risk factors, complications, and sequelae for acute otitis media, otitis media with effusion, and chronic suppurative otitis media. At least one review author independently screened titles and abstracts of the retrieved records for each condition to determine whether the research study was eligible for inclusion. Any discrepancies were resolved by reviewing the full text followed by discussion with a second review author. Studies with more than 100 participants were prioritised.

RESULTS

Over 2,000 papers on otitis media (OM) have been published since 2019. Our review has highlighted around 100 of these publications. While the amount of otitis media research on the Medline database published each year has not increased, there has been an increase in epidemiological studies using routinely collected data and systematic review methodology. Most of the large incidence studies have addressed acute otitis media (AOM) in children. Several studies have described a decrease in incidence of AOM after the introduction of conjugate PCV vaccines. Similarly, a decrease was noted when rates of coronavirus disease of 2019 (COVID-19) were high and there were major public health efforts to reduce the spread of infection. There have been new studies on OM in adults and OM prevalence in a broader range of countries and population subgroups.

CONCLUSION

Overall, the rates of severe and/or suppurative OM appeared to be decreasing. However, there is substantial heterogeneity between populations. While better use of available data is informative, it can be difficult to predict rates of severe disease without accurate examination findings. Most memorably, the COVID-19 pandemic had an enormous impact on the research and clinical services for otitis media for most of the period under review.

IMPLICATIONS FOR PRACTICE

The use of routinely collected data for epidemiological studies will lead to greater variability in the definitions and diagnostic criteria used. The impact of new vaccines will continue to be important. Some of the lessons learned during the COVID-19 pandemic concerning behaviours that reduce spread of respiratory viruses can hopefully be used to decrease the burden of otitis media in the future. There are still many countries in the world where the burden of otitis media is not well described. In countries where otitis media has been studied over many years, new potential risk factors continue to be identified. In addition, a better understanding of the disease in specific subgroups has been achieved.

Evaluation of postural stability and vestibulo-ocular reflex in adults with chronic suppurative otitis media

PURPOSE

To evaluate the vestibulospinal reflex and vestibulo-ocular reflex (VOR) in patients with chronic suppurative otitis media (CSOM) using posturography and the video head impulse test (vHIT).

METHODS

Sixty-five patients with CSOM and 65 healthy participants as controls were included. Patients with CSOM were instructed to complete the dizziness handicap inventory (DHI). All participants underwent otoscopy, pure-tone audiometry, posturography sensory organization test (SOT), and vHIT.

RESULTS

Patients with CSOM exhibited a high prevalence of dizziness. The CSOM group had poor SOT vestibular scores compared to the control group. Patients with CSOM had worse sways in the antero-posterior and mediolateral planes. The CSOM group was divided into two subgroups according to the type of hearing loss. SOT vestibular scores were significantly poorer in the mixed hearing loss group than those in the conductive hearing loss group. We found a positive correlation between disease duration and poor SOT vestibular scores. Moreover, poor SOT vestibular scores correlated with high DHI scores. We found abnormalities in the vHIT results in the CSOM group in the form of low VOR gain and corrective saccades.

CONCLUSION

Our study provides clinical evidence of dizziness, poor postural control, and VOR abnormalities in patients with CSOM. The presence of sensory elements of hearing loss in patients with CSOM appears to be positively associated with vestibular dysfunction.

Comparison of Disease-Specific, Generic, and Hearing-Specific Instruments Assessing Health-Related Quality of Life in Patients Undergoing Middle Ear Surgery for Chronic Otitis Media: A Prospective Correlational Study

OBJECTIVE

This study aimed to determine the responsiveness of three instruments (disease-specific, generic, and hearing-specific) assessing health-related quality of life (HRQoL) in adult patients undergoing surgery for chronic otitis media (COM).

STUDY DESIGN

Prospective correlational study.

SETTING

Two otology referral centers in England, United Kingdom.

PATIENTS

Consecutive adult patients undergoing middle ear surgery for COM.

MAIN OUTCOME MEASURES

HRQoL assessment and audiometry were performed preoperatively and 12 months after surgery. HRQoL was assessed using disease-specific (Chronic Otitis Media Questionnaire-12 [COMQ-12]), generic (Euro-Qol-5D-5L), and hearing-specific (Hearing Handicap Inventory for Adults [HHIA]) instruments.

RESULTS

A total of 52 patients (mean [standard deviation {SD}] age, 47.3 [18.3] yr) were included, with 42 patients completing both preoperative and postoperative COMQ-12 forms. COMQ-12 and HHIA total scores significantly improved after surgery (COMQ-12: mean [SD], 28.3 [11.6] versus 14.8 [10.6]; p < 0.001; HHIA: 42.9 (28.4) versus 32.6 (27.5); p = 0.012). General HRQoL measured with the Euro-Qol-5D-5L was unaffected by surgery (p > 0.05). The standardized response means for the COMQ-12 and HHIA total scores were 1.21 and 0.44, respectively. Postoperative air conduction thresholds were moderately correlated with the postoperative COMQ-12 (r = 0.46, p = 0.005) and HHIA (r = 0.41, p = 0.012) total scores.

CONCLUSIONS

Middle ear surgery significantly improved both disease-specific and hearing-specific HRQoL, whereas general HRQoL did not change. Only the COMQ-12 is highly responsive to surgical intervention. This study supports the use of the COMQ-12 to monitor patient-reported outcomes in both research and routine clinical settings.

Quality of life after cholesteatoma surgery: comparison between surgical techniques

Objective

To evaluate the long-term quality of life (QoL) in patients operated for cholesteatoma by canal wall-up tympanoplasty (CWUT) or canal wall-down tympanoplasty (CWDT) with mastoid obliteration.

Methods

QoL was evaluated by the Chronic Otitis Media Questionnaire - 12 (COMQ-12). For each patient, the total score and three partial subscores, concerning disease activity, functional impairment and general impact on the patient’s life were calculated. These scores were correlated with the surgical technique, as well as anatomical and functional results.

Results

68 procedures were classified as CWUT and 78 as CWDT with obliteration. The mean follow-up was 65 months. Total and partial COMQ-12 scores did not show any significant difference between the two groups. Correlation analysis showed a significant direct association between the postoperative Air-Bone Gap (ABG) and both the COMQ-12 total score and functional subscore in the CWUT group.

Conclusions

This is the first study comparing CWUT and CWDT with obliteration with the COMQ-12, thus confirming the overlapping results in terms of QoL. These findings, together with the evidence of the significantly lower rates of recidivism, show that CWDT with obliteration should be considered as a good alternative to CWUT.